1/37. Iatrogenic spondylolysis leading to contralateral pedicular stress fracture and unstable spondylolisthesis: a case report.STUDY DESIGN: A case report of iatrogenic spondylolysis as a complication of microdiscectomy leading to contralateral pedicular stress fracture and unstable spondylolisthesis. OBJECTIVE: To improve understanding of this condition by presenting a case history and roentgenographic findings of a patient that differ from those already reported and to propose an effective method of surgical management. methods: A 67-year-old woman with no history of spondylolysis or spondylolisthesis underwent an L4-L5 microdiscectomy for a left herniated nucleus pulposus 1 year before the current consultation. For the preceding 8 months, she had been experiencing low back and bilateral leg pain. Imaging studies revealed a left L4 spondylolytic defect and a right L4 pedicular stress fracture with an unstable Grade I spondylolisthesis. RESULTS: The patient was treated with posterior spinal fusion, which resulted in complete resolution of her clinical and neurologic symptoms. CONCLUSIONS: Iatrogenic spondylolysis after microdiscectomy is an uncommon entity. However, it can lead to contralateral pedicular stress fracture and spondylolisthesis, and thus can be a source of persistent back pain after disc surgery. Surgeons caring for these patients should be aware of this potential complication.- - - - - - - - - - ranking = 1keywords = back pain, back, pain (Clic here for more details about this article) |
2/37. spondylolysis as a cause of low back pain in swimmers.low back pain (LBP) has recently become a common complaint in swimmers. The differential diagnosis of LBP in swimmers includes muscle and ligament sprains, Scheuerman disease, herniated disc, facet joint injury, tumors, infections, and spondylolysis. Although spondylolysis or listhesis is a frequent injury in the athlete, mainly in weightlifters, wrestlers, gymnasts, divers and ballet dancers, it is infrequently reported in swimmers. We have recently encountered four adolescent elite swimmers who complained of low back pain and were diagnosed as having spondylolysis. Three of the patients were either breast-strokers or butterfly swimmers. Plain radiography demonstrated the lesion in two patients. Increased uptake in bone scan was noted in all patients. CT was performed only in two patients and revealed the lesion in both. One patient was diagnosed within two weeks, and the diagnosis in the others was deferred for 2-7 months. The patients were treated successfully by reducing the intensity of their training program and the use of a corset for at least three months. Repeated hyperextension is one of the mechanisms for spondylolysis in athletes as is the case in breast-strokers and butterfly style swimmers. LBP in swimmers should raise the suspicion of spondylolysis. Plain radiography and bone scan should be performed followed by SPEC views, CT, or MRI as indicated. If the case is of acute onset as verified by bone scan, a boston or similar brace should be used for 3 to 6 months in conjunction with activity modification and optional physical therapy. Multidisciplinary awareness of low back pain in swimmers, which includes trainers, sport medicine physicians, and physical therapists, should lead to early diagnosis and appropriate treatment.- - - - - - - - - - ranking = 6.6076622406263keywords = back pain, back, pain (Clic here for more details about this article) |
3/37. Management of multiple level spondylolysis of the lumbar spine in young males: a report of six cases.The most common procedure for surgical treatment of lumbar spondylolysis is intertransverse processes spinal arthrodesis with instrumentation. However, this procedure is associated with significant morbidity on long-term follow up. Direct repair of spondylolysis is an alternative method for preservation of motion segment and anatomic continuity in young adults with multiple level spondylolysis. From 1992 through 1998, six soldiers with a diagnosis of multiple level spondylolysis who complained of persistent low back pain were treated in our hospital. spondylolysis involved two levels in five cases and three levels in one case. All patients underwent serial roentgenography of the lumbar spine and a staged pars interarticularis infiltration test with bupivacain 0.5%. Five patients underwent direct repair of the pars interarticularis defects with hook screws, translaminar screws, and bone graft, while one patient received conservative treatment. All surgically treated patients had either good or excellent results at a mean of 34.4 months follow-up. One patient who was treated nonsurgically still complained of sport restriction at 16 months follow-up. Direct repair of multiple pars interarticularis defects after a positive staged pars infiltration test can restore anatomic stability, relieve back pain, and preserve a greater range of motion of the lumbar spine in young patients with intact disc height.- - - - - - - - - - ranking = 1.8879034973218keywords = back pain, back, pain (Clic here for more details about this article) |
4/37. Combined dysplastic and isthmic spondylolisthesis: possible etiology.STUDY DESIGN: Four cases of combined dysplastic and higher-level isthmic spondylolisthesis were studied. OBJECTIVE: To attempt to understand the possible etiology of this unreported combination. SUMMARY OF BACKGROUND DATA: Dysplastic spondylolisthesis is thought to be hereditary. It is believed that isthmic spondylolisthesis, the more common type, is acquired. Multiple spondylolysis and spondylolisthesis have been reported, but no cases of combined dysplastic and isthmic spondylolisthesis. methods: The global and segmental Cobb angles of the lumbar vertebrae and sagittal vertical alignment were measured in four patients who presented with lower back pain and varying degrees of pain radiation to the lower limb. Posteroanterior and lateral radiographs were taken with patients standing barefooted. Three of the patients underwent surgery. The fourth patient refused surgery. RESULTS: The global and segmental Cobb angles were found significantly increased in these patients. Increased segmental extension angles were clearer at the levels above the dysplastic vertebrae and at the level of the isthmic defect. Large anterior translation of the thorax was noted in all cases. CONCLUSIONS: The authors believe that this unusual combination may have resulted from hyperlordosis occurring above the dysplastic vertebrae, which caused increased stresses that led to the isthmic defect. This combination should be investigated in patients with dysplastic spondylolisthesis and hyperlordosis.- - - - - - - - - - ranking = 0.960347288739keywords = back pain, back, pain (Clic here for more details about this article) |
5/37. Pedicular stress fracture in lumbar spine.The purpose of this article is to report two cases of pedicular stress fracture of the lumbar spine, which is an uncommon cause of low back and leg pain. The relevant literature is reviewed and features of the cases that differ from those already reported are highlighted. One of our cases of pediculolysis is the first in the literature for that is caused by rotational instability induced by laminectomy. The remodeling of the fractured pedicle was striking when compared with its normal counterpart. To the authors' knowledge, this is the first report of a pediculolysis with T2-weighted imaging findings. In addition, we report the computed tomographic (CT) and magnetic resonance (MR) imaging findings of a healed pediculolysis that has not been reported previously.- - - - - - - - - - ranking = 0.056048251339099keywords = back, pain (Clic here for more details about this article) |
6/37. Acute progression of spondylolysis to isthmic spondylolisthesis in an adult.STUDY DESIGN: Acute progression of spondylolysis to spondylolisthesis in an adult without degenerative disc disease at the slip level is reported. OBJECTIVE: To document a case of adult-onset progression of isthmic spondylolisthesis, in which the disc space height at the slip level was normal. There were no known risk factors for progression, and the olisthesis occurred acutely after minimal trauma. SUMMARY OF BACKGROUND DATA: adult progression of spondylolysis to spondylolisthesis is reported infrequently because the highest risk for slip progression is before skeletal maturity. Previous reports documenting progressive slips in adults have uniformly related the olisthesis to progressive disc collapse and subluxation below the pars defect. methods: A 39-year-old woman was evaluated for a primary complaint of back and bilateral leg pain. Standing radiographs of her lumbar spine showed an L4-L5 and L5-S1 spondylolysis without spondylolisthesis. She had severe degenerative disc changes at L5-S1. The disc space height was normal at L4-L5. Two years later she was essentially immobilized by back pain after minimal trauma. Standing radiographs demonstrated a new Grade 2 L4-L5 isthmic spondylolisthesis. As demonstrated by magnetic resonance imaging, spontaneous reduction of the olisthesis has occurred with normal disc space height maintained. RESULTS: An L4-S1 anterior lumbar interbody fusion and posterior decompression and spinal fusion with instrumentation were performed without complication. At this writing, the patient has returned to work and is doing well 1 year after surgery. CONCLUSIONS: This case is important because it illustrates the potential for acute progression of spondylolisthesis with minimal trauma. A patient with known spondylolysis who sustains acute severe exacerbation of his or her back pain should have repeat standing radiographs.- - - - - - - - - - ranking = 1.9439517486609keywords = back pain, back, pain (Clic here for more details about this article) |
7/37. spondylolysis of L2 in identical twins.OBJECTIVE: To discuss the presence of spondylolysis at L2 in identical twins. CLINICAL FEATURES: Twin 61-year-old brothers reported insidious low back pain (LBP) of relatively recent onset. Both engaged in running as their main form of exercise. One had spondylolisthesis and history of significant traumatic incident; the other had no spondylolisthesis but a much more strenuous running regimen. INTERVENTION AND OUTCOME: Both patients underwent a course of chiropractic treatment for mechanical LBP and reported a 50% overall improvement in symptoms. CONCLUSIONS: spondylolysis at L2 is uncommon, and although a familial component regarding weakness of the pars interarticularis has been demonstrated in the literature, spondylolysis at L2 in twins is extremely rare. Questions remain regarding the cause of spondylolisthesis in patients.- - - - - - - - - - ranking = 0.9439517486609keywords = back pain, back, pain (Clic here for more details about this article) |
8/37. An instance of an atypical intraspinal cyst presenting as S1 radiculopathy: a case report and brief review of pathophysiology.Intraspinal cysts are rare, but typically they originate from a degenerate zygapophyseal joint. These cysts have been commonly referred to as juxtafacet cysts and occur concomitantly with lumbar and occasionally lower-limb radicular pain. Documented cases have shown pseudoarthroses developing from nonhealing pars defects. Histologic analyses have found synovial tissue within these fibrocartilaginous accumulations. We present a case of S1 radiculopathy indicated by an intraspinal pseudocyst arising as a complication of a chronic spondylolytic defect. A brief review of the related pathophysiology is also included.- - - - - - - - - - ranking = 0.016395540078096keywords = pain (Clic here for more details about this article) |
9/37. Dissociation between back pain and bone stress reaction as measured by CT scan in young cricket fast bowlers.BACKGROUND: Bone stress reaction is prevalent among cricket fast bowlers. Few studies have addressed the sensitivity and specificity of imaging for diagnosis, and follow up assessment has been poorly investigated. OBJECTIVE: To determine whether there was an association between back pain and bone stress reaction as measured by computed tomography (CT) scan in young cricket fast bowlers. methods: Ten young cricket fast bowlers were included in the study. Nine bowlers presented to a physiotherapy practice with low back pain and were later diagnosed with lumbar stress fractures, while one was an experienced bowler with no pain. All players had a CT scan after presenting to the physiotherapy practice. Pain was assessed according to a subjective scale (0-10) where 10 represented the player's subjective, maximum pain score. Recovery and rehabilitation of all players was monitored until they returned to full participation. RESULTS: There was no consistency in the relationship between pain and CT scan results. For example, one subject had evidence of un-united stress fractures after 15 months of rest but had experienced moderate pain for only 2 weeks after the onset of symptoms, in contrast to another subject who had intermittent pain for 11 months even though CT scan showed multiple stress fractures ranging from partially healed to fully healed status at 3 months. CONCLUSION: There is dissociation between back pain and bone stress reaction as measured by CT scan. Therefore, CT scan does not provide objective evidence for ongoing management or decision concerning return to sport in cricket fast bowlers.- - - - - - - - - - ranking = 6.6896399410168keywords = back pain, back, pain (Clic here for more details about this article) |
10/37. Degenerative disc disease in childhood and adolescence.Degenerative disk disease (DDD) is a common cause of low back pain and leg pain in children and infants. DDD is often unrecognized and under-diagnosed. This paper presents six cases of DDD in children and discusses the clinical presentation and pathophysiology of DDD.- - - - - - - - - - ranking = 0.960347288739keywords = back pain, back, pain (Clic here for more details about this article) |
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